Table 3.

Clinical studies evaluating applications of telehealth in urinary the management of urinary stone disease.

Reference	Study design	Cases	Studied intervention	Methods	Endpoint	Results
Diagnosis and treatment planning
Hayes (1998) [9]	Prospective series	32	Telemedicine consultations for complex and/or complicated urinary stone disease vs only telephone consultations	Virtual consultations to discuss complicated urinary stone disease, which was already discussed by telephone consultation. During the virtual consultation, specific tools, including zooming, pointing, and drawing, were used by the urologists to view and annotate the image, explaining the surgical approach to the patient and the referring urologist before transfer	To assess the effectiveness of telemedicine on the clinical decision-making process for patients with urolithiasis	The recommendation of the consulting urologist at the tertiary center was altered in 12 patients (37.5%) after the telemedicine consultation, compared with the recommended treatment after the initial telephone consultation
Johnston, (2005) [11]	Prospective series	11	Remote assessment of CT images	Selected images from CT scans were compressed and delivered by e-mail for urological assessment	To assess the concordance among initial radiological diagnosis on CT scans and urologist assessment of selected images sent by e-mails	Hydronephrosis was correctly identified 100% of the time, while perinephric stranding was correctly identified 80% of the time. Stone presence and location were correctly identified in 80% of the cases
						One 3-mm lower-ureteral calculus and one 1-mm pelvic calculus were not identified. Stone size was estimated within 1 ± 1 mm compared with the staff radiologist’s report
Connor, (2019) [46]	Prospective series	1008	Specialist- led virtual ureteric colic clinic in patients with uncomplicated acute ureteric colic	Patients with uncomplicated acute ureteric colic referred in real-time by clinicians using an electronic referral method integrated into the electronic health care record platform and a virtual clinic telephone consultation. After the call, the patient could have the following outcomes: discharge investigations and a further virtual clinic, and face-to-face clinic or direct referral for stone intervention. The virtual clinic was supervised by 3 dedicated urologists. In the case of clinical uncertainty, the patient would be referred to a standard clinic	To evaluate the clinical, fiscal, and environmental impact of a specialist-led acute ureteric colic virtual clinic pathway	The median (interquartile range) time from presentation to virtual clinic outcome was 2 (4) d. The outcomes were as follows: 16.3% of patients were discharged, 18.2% were discharged after further virtual clinic, 17.2% underwent an intervention, and 48.4% were referred to a standard clinic. Introduction off a virtual clinic saved £145, 152 for NHS. Overall, 15,085 patient journey kilometers were avoided, equal to 0.70–2.93 metric tons of carbon dioxide equivalent production
Telementoring
Rodrigues Netto, (2003) [10]	Case report	2	Telementoring	Telementoring during laparoscopic bilateral varicocelectomy and a percutaneous renal access for a percutaneous nephrolithotomy via AESOP 3000 (Computer Motion Inc., Cremona Drive Goleta, CA, United States) and PAKY robots	None	The two procedures were completed successfully
Post-surgical evaluation
Aydogdu, (2019) [44]	Randomized controlled	40	Standard rounds	Patients undergoing percutaneous nephrolithotomy were randomly divided into two groups. Group 1 included 40 patients who were followed- up with standard rounds and group 2 included 40 patients who were followed-up with telerounding in addition to standard rounds. Telerounding was performed with a high- quality tablet using the Skype application. Additional telerounding visits by the operating surgeon, were performed on the evening before the surgery and each night during the hospital stay of the patients postoperatively	Patient and surgeon satisfaction rates were assessed with a VAS scale. Both surgeon and patients filled in the “satisfaction” and “quality of telerounding conference” surveys on the day of discharge	The mean time of preoperative telerounding visit was 3.65 ± 0.59 (2–4) min. The mean time of telerounding visits on the postoperative 1st and 2nd days were 3.80 ± 0.62 and 2.9 ± 0.91 min, respectively. The VAS score evaluating the surgeon’s satisfaction rate for telerounding was 91 ± 11.2, and patients expressed a high level of satisfaction (72.5%)
Therapies for the prevention of stone recurrence
Gasparini, (2019) [47]	Prospective series	500	Telemedicine program to enroll patients at high risk of recurrent kidney stones and provide dietary instruction, metabolic evaluation, and medical therapy	The program was staffed by a clinical pharmacist and supervised by urologists following a protocol based on the American Urological Association guidelines. Patients were contacted entirely via telemedicine. A telephone follow-up occurred at a minimum of 6-wk, 3-mo, 6-mo, and 12-mo intervals in the 1st first year; more frequent follow-up occurred if laboratory, medication, or compliance issues arose. After the 1st first year, telephone follow-up occurred annually.	To determine the feasibility of a multicenter, pharmaciststaffed program to enrol patients at high risk of recurrent kidney stones and provide dietary instruction, metabolic evaluation, and medical therapy via telemedicine.	Among patients enrolled for 3 mo, 99% self-reported compliance with at least 3 of 5 aspects of dietary advice. A complete metabolic evaluation including 24-h urine collection was performed in 80% of patients by 12 mo.
						A significant improvement in all urinary parameters occurred in 52 patients with calcium stones who repeated 24-h urine testing. The 12-mo dropout rate was 12.4%.

CT = computed tomography; NHS = National Health Service; PAKY = Percutaneous Access to the Kidney; VAS = visual analog scale.